Emergency department referrals: Factors influencing physician referral decisions

The premise that customer satisfaction leads to repeat business is well documented in the literature (Guetek, 1995; Rogelberg and Creamer, 1994; Schneider et al. 1996). Extending this premise to the medical field, it seems reasonable to infer that physician satisfaction is related to physician referrals, a form of repeat business. While this inference seems "reasonable," little research exists regarding the relationship between physician satisfaction and physician referrals to Emergency Departments (ED), a key point of entry into many hospitals. The purpose of this research is to explore the physician ED referral processes, identify the variables that influence ED referral practices, and assess the relationships between physician satisfaction and physician ED referrals.;Participants consisted of 125 physicians from the Midwest spanning thirty different specialty areas. The majority of the physicians were randomly selected (n = 103) and a convenience sample consisted of 22 physicians. Each physician participated in a face-to-face interview where they were presented with 16 criteria and asked to rate how much each factor contributed to their ED referral decision. Participants also completed the SERVQUAL instrument that measured physician expectations of the ED and physician ED performance ratings on 22 dimensions of service quality.;A MANOVA analysis found no significant differences existed between the two recruitment groups. Therefore, both samples were combined for further analyses. Overall, individual items from both the key criteria and the SERVQUAL accounted for more regression model variance than factor solutions generated by both data sets.;The results of the key criteria analyses indicated that while the second most important criterion "your satisfaction with the ED" accounted for the most variance in the overall ED quality, overall physician satisfaction, and the referral decision regression models.;Analyses of the SERVQUAL data suggests that the performance data was the best predictor of overall ED quality, overall physician satisfaction, and the referral decision. Analyses of the Mean Superior Service (MSS) composite variable (expectation performance) indicated that ED performance was rated below physician expectations on all of the SERVQUAL dimensions. The item "providing services to your patients in your in a timely fashion" had the largest performance gap while the item "modern equipment" had the smallest performance gap.;Although this research does provide a link between physician satisfaction and ED referral decisions, the generalizability of these findings is limited. Despite these limitations, the data suggests that psychological factors are indeed related to and a part of physician expectations of ED services, physician ratings of ED performance, and the ED referral decision.